title: Shock state: an unrecognized and underestimated presentation of drug reaction with eosinophilia and systemic symptoms.
abstract: Some patients with drug reaction with eosinophilia and systemic symptoms (DRESS) are probably admitted in intensive care unit (ICU), but data concerning their clinical features at admission are scarce. Therefore, in the present study, we used a clinical network of French intensivists to study the clinical features and evolution of DRESS patients hospitalized in ICU. A national, retrospective, multicenter study collected DRESS cases hospitalized in ICU for DRESS from 2000 to end of 2011. All files were analyzed through the RegiSCAR scoring system as "no," "possible," "probable," or "definite" DRESS. Patients were included only if they had a probable or definite DRESS. Demographic, hemodynamic, biological, and infectious data were recorded. Twenty-one patients were included. Hospital mortality was 10 (47%) of 21, and 16 of 21 patients had on admission a shock state necessitating vasopressor agents. Echocardiographic ejection fraction in shock patients was depressed (47% ± 13%). Mechanical ventilation was required in 13 of 21 cases. Hepatic failure was observed in 11 of 21 cases, acute renal failure in 18 of 20 cases, and lactic acidosis in 12 of 20 patients. Initial bacteriology was negative in all patients. Human herpesvirus reactivations were found in five of 15 cases. In conclusion, shock without bacteriological documentation associated with multiple organ failure is the most common presentation of DRESS at admission in ICU and is associated with a higher mortality than previously described.
authors.affiliation: *CHU Nancy, Service de Réanimation Médicale Brabois; Pole Cardiovasculaire et Réanimation Médicale, Hôpital de Brabois, Vandoeuvre-les-Nancy; †Université de Lorraine, Nancy; ‡INSERM U1116, Groupe Choc, Faculté de Médecine; and §CHU Nancy, Service de Dermatologie, Hôpital de Brabois, Vandoeuvre-les-Nancy, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Kimmoun
authors.forename: Elsa
authors.initials: E
authors.lastname: Dubois
authors.forename: Pierre
authors.initials: P
authors.lastname: Perez
authors.forename: Annick
authors.initials: A
authors.lastname: Barbaud
authors.forename: Bruno
authors.initials: B
authors.lastname: Levy
mesh_terms: D000328:Adult; D000368:Aged; D063926:Drug Hypersensitivity Syndrome / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy / Q000821:virology; D005260:Female; D005602:France / Q000453:epidemiology; D006439:Hemodynamics / Q000502:physiology; D006564:Herpesviridae / Q000502:physiology; D006566:Herpesviridae Infections / Q000150:complications; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D011379:Prognosis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012769:Shock / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D014775:Virus Activation